Workforce shortages have pushed dental practices to rethink who does what, and in some states, regulators are starting to redraw the lines themselves.
As of this summer, nine states had expanded what dental assistants can legally do. Missouri’s proposed rule would go further, bundling both periodontal charting and scaling into the assistant’s scope — a move the Missouri Dental Hygienists’ Association has already sued to block.
Six dentists recently connected with Becker’s to talk through how changing scope of practice can change how dental offices operate and provide care, as well as the changes that could make sense.
Question: With a number of states expanding scope of practice for dental staff, if you could redraw the lines for dental staff’s scope, what is one task you’d shift to another team member, and one you’d keep how it is?
Murat Ayik, DDS. Partner of Specialty1 Partners (Houston): Dentistry needs to rethink how we utilize the talent already in our practices. I would expand the role of properly trained and credentialed dental assistants to include more routine clinical procedures, such as digital imaging, intraoral scanning, isolation techniques and temporary restorations. These are responsibilities that qualified team members can take on with appropriate training and oversight, allowing dentists to focus on more complex procedures.
What I would never delegate is the final decision on whether a tooth should be saved or extracted. In endodontics, that decision can change the course of a patient’s oral health for a lifetime. We need to stop measuring efficiency by how much the doctor does and start measuring it by how effectively we use the entire dental team, without compromising patient care.
William Elza, DMD. Associate Professor and Director of Clinical Digital Technology at
Midwestern University College of Dental Medicine – Arizona (Glendale): The task I’d shift: the chairside digital workflow. I would hand it to the dental assistant from start to finish: intraoral scanning, computer-aided design of the restoration, milling or 3D printing and finishing. These are technical, repeatable, software-guided steps and a trained and calibrated dental assistant can perform them at a very high level. In too many offices the dentist is still the bottleneck in a workflow that does not need to run through them.
The task I’d keep exactly where it is: the dentist’s three checkpoints. The dentist reviews the treatment plan, approves the design and seats the final restoration. Those are the points where clinical judgment and responsibility for the patient come together, and they belong with the dentist. Everything between them can be delegated, because a digital workflow produces a record the dentist can check at each checkpoint before anything goes in the patient’s mouth. I’d draw the lines around demonstrated competency instead of job title. If a task can be taught, measured and verified before it reaches the patient, it is a good candidate to delegate.
Shad Lewis, DMD. Dentist at Preventive Dental (Reading, Pa.): Missouri’s proposal bundles two very different jobs, so let’s split them. The task I’d shift is periodontal charting. A well-trained assistant can hold a probe and record six numbers per tooth as accurately as anyone. It’s measurement and measurement can be taught. Let the assistant do it.
The task I’d keep exactly where it is, scaling, and more importantly, the decision to scale. Those numbers only mean something once someone reads them against the bone, the history and the person in the chair and decides whether this mouth needs a deep cleaning or a better toothbrush. That call belongs to the dentist and the treatment belongs with the dentist or a licensed hygienist.
Here’s what worries me about the proposed change in Missouri. Give the same lower-cost team member both the probe and the scaler in a production-driven office and you’ve built a very efficient machine for finding pockets that need scaling. The person measuring the problem should not be the person paid to fix it. That’s not a knock on assistants. It’s a knock on incentives, which have never once in history declined an invitation.
The broader truth is that expanded duties mostly let offices chase volume. They spread the same shrinking fee across cheaper hands so more patients move through more chairs. Reimbursement has trailed inflation for years and that’s what drives the staffing shortage. Letting someone else hold the scaler won’t change that.
David Nguyen, DMD. CEO of URBN Dental (Houston): If I could shift one responsibility, I would support allowing properly trained and certified expanded-function dental assistants to place and finish direct restorations under the direct supervision of a licensed dentist, after the dentist has completed the tooth preparation. With structured education, demonstrated competency and proper oversight, this could improve clinical efficiency and access to care.
However, I would keep periodontal charting, scaling and root planing within the scope of licensed dental hygienists and dentists. These procedures are extremely technique-sensitive and require formal schooling, extensive hands-on clinical training and a comprehensive understanding of periodontal anatomy, health and disease. Periodontal charting isn’t simply recording numbers. Accurate probing requires clinical judgment, and inaccurate measurements can directly impact diagnosis and treatment decisions.
As the CEO of a multilocation dental organization, I understand the importance of operational efficiency and addressing workforce shortages. But expanding scope of practice should be driven by education and clinical competency, not simply the need to increase productivity or reduce labor costs. We should empower dental assistants to grow professionally while maintaining the clinical standards our patients deserve.
Hubble Reichert, DDS. Chief Dental Officer of Crescent Community Health Center (Dubuque, Iowa): One task I would delegate more broadly is taking final impressions for straightforward restorative cases to appropriately trained dental assistants under indirect dentist supervision. With demonstrated competency, clear protocols and dentist review, this could improve clinic efficiency and allow dentists to focus more time on diagnosis and treatment.
One task I would keep within the scope of dentists and dental hygienists is scaling. I would not be comfortable expanding that responsibility to dental assistants. The clinical judgment and instrumentation skills involved should remain with providers whose education and training specifically prepare them for that care.
I support greater flexibility in supervision requirements for appropriately trained assistants, while keeping clear expectations for competency and dentist accountability. Expanding access should preserve the quality of care patients receive.
Robert Trager, DDS. Dentist at John F. Kennedy International Airport (New York City): In today’s dental environment, there is a well-known shortage of dental assistants and hygienists. The medical profession solved their shortage problem by developing a new category called nurse practitioners and PA (physician assistants). They are allowed to perform many medical procedures; some with or without supervision. The dental profession, because of the shortage of auxiliaries, should allow further training of those dental assistants that are capable and are incentivized to be trained to perform many dental disciplines such as using a cavitron, scaling, periodontal charting and impressions for study model and prosthetic procedures. Also, other disciplines they should be allowed to perform are placing bands around teeth for operative and orthodontic procedures as well as minor suturing and suture removal.
These individuals will be fully trained and be under the supervision of the employing dentist. Also, there would be a salary increase, better benefits and the feeling of being a complete member of the team. Multi-tasking is the way of the future, otherwise robots are now being invented that can do many of these procedures. Would you rather have a human being working on your mouth or a hand of steel from a robot? The only discipline that I would not change is giving anesthesia unless a fully trained course is given.
